Conference Papers
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This collection contains abstracts of conference papers, presented at local and international conferences by the staff of the Faculty of Medicine
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Item Adverse drug reactions in a cohort of Sri Lankan patients with non-communicable chronic diseases(Sri Lanka Medical Association, 2016) Shanika, L.G.T.; Wijekoon, C.N.; Jayamanne, S.; Coombes, J.; de Silva, H.A.; Dawson, A.INTRODUCTION AND OBJECTIVES: Adverse drug reactions (ADRs) are a major problem in drug utilization. The study aimed to describe the incidence and nature of ADRs in a cohort of Sri Lankan patients with non-communicable chronic diseases (NCCDs). METHOD: This prospective observational study conducted in a tertiary-care hospital recruited in-ward patients with NCCDs. All ADRs that occurred during the index hospital admission and in the 6-month period following discharge were detected by active surveillance. Details were recorded using the ADR reporting form, developed based on the publication of the Clinical Center, Pharmacy Department, National Institutes of Health. RESULTS: 715 patients were studied (females-50.3%, mean age–57.6 years). The mean number of medicines given per patient was 6.11±2.97. The most prevalent NCCDs were hypertension (48.4%; 346/715), diabetes (45.3%; 324/715) and ischemic heart disease (29.4%; 210/715). 112 patients (15.7%) experienced at least one ADR. In the 112 patients, 154 ADRs (33 during index hospital admission; 121 during 6-month period following discharge) were detected. 51.9% (80/154) of them were potentially avoidable. 47% (73/154) of ADR swere Serious Adverse Events (SAEs); 13 were life threatening, 46 caused hospitalization and 14 caused disability. The most common causes for re-hospitalization due to ADRs were hypoglycemia due to anti-diabetic drugs (17/46), bleeding due to warfarin (14/46) and hypotension due to anti-hypertensives (6/46). CONCLUSIONS: Incidence of ADRs was high in the study population. A large proportion of them were SAEs. The majority of ADRs that required re-hospitalization were caused by widely used medicines and were potentially avoidable.Item Impact of a ward-based clinical pharmacy service in reducing drug-related hospital re-admissions in patients with chronic non-communicable diseases; evidence from a controlled trial in Sri Lanka(Sri lanka Medical Association, 2015) Shanika, L.G.T.; Wijekoon, N.; Jayamanne, S.; Coombes, J.; Mamunuwa, N.; Dawson, A.; de Silva, H.A.INTRODUCTION AND OBJECTIVES: Literature showed that pharmacists' interventions helped to reduce drug related hospital re-admissions. The objective of this study was to determine the impact of a ward-based clinical pharmacy service on drug related hospital re-admissions in Sri Lanka. METHOD: This was a part of a controlled trial conducted in a tertiary care hospital in Sri Lanka to evaluate the clinical pharmacy service. The intervention group (IG) received a clinical pharmacist's service in addition to the standard care provided to control group (CG). The pharmacist performed a prospective medications review of patients with chronic non-communicable diseases during hospital stay and made recommendations to the health care team when appropriate. At discharge reconciliation of discharge prescription was done. Patients were educated about discharge medicines to improve knowledge and compliance. Both groups were followed up monthly for six months to identify drug-related hospital re-admissions. RESULTS: Of 137 drug-related re-admissions, 93 (involving 87/356 patients) were from the CG, and 44 (involving 42/361 patients) were from the IG {P < 0.001). Non-compliance was the main reason for re-admissions in the CG. Significantly higher incidence of non-compliance per patient were recorded in CG (CG vs. IG: 13.8% vs. 4.2%; P < 0.001). There was a significantly higher percentage of re-admissions per patient in the CG due to unintentional omission of drugs on discharge prescription (CG vs. IG: 4.5% vs. 0.3%; P < 0.001). The percentage of re-admissions per patient due to adverse drug reactions was similar in the two groups. CONCLUSION: The ward-based clinical pharmacy service is useful in reducing drug related hospital re-admissions in patients with chronic non-communicable diseases. clinical pharmacist's service in addition to the standard care provided to control group (CG). The pharmacist performed a prospective medications review of patients with chronic non-communicable diseases during hospital stay and made recommendations to the health care team when appropriate. At discharge reconciliation of discharge prescription was done. Patients were educated about discharge medicines to improve knowledge and compliance. Both groups were followed up monthly for six months to identify drug-related hospital re-admissions. RESULTS: Of 137 drug-related re-admissions, 93 (involving 87/356 patients) were from the CG, and 44 (involving 42/361 patients) were from the IG {P < 0.001). Non-compliance was the main reason for re-admissions in the CG. Significantly higher incidence of non-compliance per patient were recorded in CG (CG vs. IG: 13.8% vs. 4.2%; P < 0.001). There was a significantly higher percentage of re-admissions per patient in the CG due to unintentional omission of drugs on discharge prescription (CG vs. IG: 4.5% vs. 0.3%; P < 0.001). The percentage of re-admissions per patient due to adverse drug reactions was similar in the two groups. CONCLUSION: The ward-based clinical pharmacy service is useful in reducing drug related hospital re-admissions in patients with chronic non-communicable diseases.Item Impact of a ward-based clinical pharmacist on improving medication knowledge and adherence in patients with chronic non-communicable diseases(Sri lanka Medical Association, 2015) Shanika, L.G.T.; Wijekoon, N.; Jayamanne, S.; Coombes, J.; Coombes, I.; Perera, D.; Pathiraja, V.; Dawson, A.; de Silva, H.A.INTRODUCTION AND OBJECTIVES: This is the first study done in Sri Lanka to evaluate the benefit of a ward-based pharmacist on improving medication knowledge and adherence in patients with chronic non-communicable diseases. METHOD: This is a part of a controlled trial conducted in a tertiary care hospital to evaluate ward-based clinical pharmacy service. Intervention group (IG) received a ward-based pharmacist's service during hospitalization to optimize the patients' drug therapy. At discharge the pharmacist counseled patients regarding all aspects (name, indication, dose, frequency, side effects, and actions for side effects, timing, monitoring and storage) of long term medications and written instructions were also provided. Control group (CG) received usual care without a ward-based pharmacist. The knowledge and adherence were assessed over the phone on the 6th day after discharge by a different pharmacist. Previously validated knowledge and adherence questionnaires were used. RESULTS: There were 334 and 311 patients in the IG and CG, respectively, The IG had a significantly higher average medication knowledge compared to the CG {IG-75.81+19.14 vs. CG-40.84+19.20; P < 0.001). Proportion of drugs with correct answers, to all 9 dimensions tested, was greater in the IG compared to the CG (P < 0.001). IG had a significantly higher medication adherence score compared to the CG (IG-92.97±15.04 vs. CG-80.42±28,29; P <0.001). A significantly large number of individuals in the IG had high adherence score on Morisky adherence scale compared to the CG (P < 0.001). CONCLUSION: Discharge counseling by a ward-based pharmacist improves medication knowledge and adherence of patients on long term medications.Item Prevention of acute adverse reactions to snake antivenom after snakebite: multi-centre, randomized, controlled clinical trial(Sri Lanka Medical Association, 2009) de Silva, H.A.; Ranasinha, C.D.; Pathmeswaran, A.; Jayamanne, S.; Kalupahana, R.; Ratnathilake, G.A.; Ariyasena, H.; Uluwatte, W.; Lalloo, D.; Armitage, J.; Aronson, J.K.; de Silva, H.J.BACKGROUND: Antivenom is the most effective treatment for snakebite envenoming. Acute adverse reactions to the polyvalent antivenom (PAV) are common; anaphylactk reactions are particularly serious. OBJECTIVE: To determine whether promethazine, hydrocortisone, and low-dose adrenaline, alone and in all possible combinations, prevent reactions to antivenom. METHODS: The study was conducted in 3 hospitals in Sri Lanka from March 2005 to April 2008. It required 1000 patients to detect a 25% reduction in reactions at p<0.01 with 80% power. After informed consent, patients were randomized in a 2x2x2 factorial blinded design to receive each active intervention versus matching placebo immediately before administration of PAV. They were monitored for adverse reactions categorized as mild, moderate, severe, for at least 96 hours. The pre-specified primary analyses were of effects of each intervention on the incidence of severe reactions over 48 hours. Results: Of 1007 randomized subjects 776 (77.2%) were males, mean (sd) age 36.5 (13.6) yrs. Median time between snakebite and PAV administration was 4.25 hours. 752 (75%) patients developed acute reactions to PAV; 9% mild, 48% moderate and 43% severe. None of the drugs significantly reduced severe reactions to PAV at any time point. However, there was an 18% reduction in the rate of severe reactions at 1 hour with adrenaline (p-0.052) and a 33-3% reduction in signs of allergy (pruritus, urticaria, facial oedema, bronchospasm) with promethazine at 1 and 24 hours (p<0.001). CONCLUSIONS: Pre-treatment with promethazine, hydrocortisone, and low-dose adrenaline alone and in different combinations do not significantly reduce acute reactions to PAV.Item Low-dose adrenaline, promethazine and hydrocortisone, (alone and in combination) in the prevention of acute adverse reactions to antivenom following snakebite: a randomised, double blind, placebo-controlled trial(Sri Lanka Medical Association, 2011) de Silva, H.A.; Pathmeswaran, A.; Ranasinha, C.D.; Jayamanne, S.; Samarakoon, S.B.; Hittharage, A.; Kalupahana, R.; Ratnatilaka, G.A.; Uluwatthage, W.; Aronson, J.K.; Armitage, J.M.; Lalloo, D.G.; de Silva, H.J.INTRODUCTION AND OBJECTIVES: Envenoming from snakebites is most effectively treated by antivenom. However, the antivenom available in South Asian countries commonly causes acute allergic reactions, anaphylactic reactions being particularly serious. We have assessed whether adrenaline, promethazine, and hydrocortisone prevent such reactions in secondary referral hospitals in Sri Lanka. METHODS: We randomized 1007 patients, using a 2x2x2 factorial design, in a double-blind, placebo-controlled trial of adrenaline (0.25 mi of a 1:1000 solution subcutaneously), promethazine (25 mg intravenously), and hydrocortisone (200 mg intravenously), a!one and in all possible combinations. The interventions or matching placebo were given immediately before infusion of antivenom. Patients were monitored for mild, moderate, or severe adverse reactions for at least 96 hours. The pre-specified primary endpoints were the effects of the interventions on the incidence of severe reactions over 48 hours. Results: 752 (75%) patients had acute reactions to antivenom; 9% mild, 48% moderate, 43% severe; 89% of the reactions occurred within one hour and 40% of all patients were given rescue medication during the first hour. Compared with placebo, adrenaline significantly reduced severe reactions to antivenom by 43% at one hour (95%CI 25-67) and by 38% (26-49) over 48 hours; hydrocortisone and promethazine did not. Adding hydrocortisone negated the benefit of adrenaline. CONCLUSIONS: Pre-treatment with tow-dose adrenaline was safe and reduced the risk of acute severe reactions to snake antivenom. This may be of particular importance in countries where adverse reactions to antivenom are common, although the need to improve the quality of available antivenom cannot be overemphasized.Item Impact of a ward based clinical pharmacist intervention on improving the quality use of medicines in patients with chronic non communicable diseases in a tertiary hospital(Sri Lanka Medical Association, 2014) Shanika, L.G.T.; Jayamanne, S.; Wijekoon, N.; Coombes, J.; Coombes, I.; Perera, D.; Dawson, A.; de Silva, H.A.INTRODUCTION AND OBJECTIVES: To investigate the impact of a ward based clinical pharmacy service (CPS) on appropriate prescribing of discharge medications. METHODS: This is a non-randomised controlled trial conducted to assess CPS in a medical unit. Eligible patients admitted with non-communicable chronic diseases were considered. The female and the maie wards were the control and intervention during initial phase. Groups were swapped between two wards during next phase. The control patients received usual management. Intervention received CPS in addition to the existing management. Both clinical and demographic data were collected until discharge. Appropriateness of prescribing was assessed at discharge with the Medication Appropriateness Index (MAI). RESULTS: 354 (2140 medications) and 359 (2232 medications) patients' data were evaluated respectively in, control and intervention. Medications received per patient in both groups were similar. Appropriateness of discharged medications in intervention' group was significantly higher compared to control, 66% (235/359) and 34% (120/354) respectively (p< 0.0001). Furthermore, the mean MAI score per patient was significantly lower in intervention compared to th.e control (0.99 vs. 4.1, p< 0.001). Proportion of appropriate prescriptions in relation to all MAI criteria was significantly lower in intervention group compared to the control, all (p< 0.01). Among the drugs prescribed in the intervention [5% (112/2232)] and control groups, [20% (420/2140)] respectively had at least one inappropriate MAI criterion (p< 0.0001). CONCLUSIONS: This study demonstrates that a ward based CPS can reduce inappropriate prescribing of medications at discharge providing an opportunity to improve quality use of medicine.